May 20, 2024
“You must learn to let go. Release the stress. You were never in control anyway.”
Steve Maraboli
Chapter 2a
Stress and a Woman's Ability to Conceive - The Healthy Mind Is Key.
How was it meant to be? Humans were designed to be excellent at handling acute stress while chronic stress on the other hand was never expected to be part of our day to day existence. We run from the tiger and survive the event or we die. That being said, chronic mental stress is the greatest disruptor of human balance and health. To truly know this fact and work towards alleviating it is the immediate route to a healthy life and a healthy pregnancy. Mental stress has profound negative effects on immune and hormonal function to the detriment of mom and her babe. Chronic mental stress is known to disrupt pregnancy conception and perinatal events. Perception of one’s stress is often more important than the event itself. Becoming aware of your perceptions and working toward a minimally stressed mind is a key to a healthy pregnancy. A woman should be honored and protected while pregnant to keep external stress levels low. In this chapter, you will learn why and how stress has the ability to hurt a pregnancy. The to do section gives tools to reverse the negative process.
I have long wondered what it takes to reach the mind of an apparently healthful person heading down the wrong path toward disease. I have unfortunately found that the vast majority of people refuse to hear the word of health until disease hits them hard and even then, a subset still refuse to listen.
This is all about stress.
In becoming a mother, chronic physical or mental stress can wreak havoc on hormonal balance and metabolic responses which are critical for conception and development. The good news is that I have found that mother's to be are more motivated than the general population to be healthy for their prospective newborn.
To understand how stress affects a pregnancy, we need to understand what happens when someone is stressed?
Humans and mammals are capable of responding to acute stress robustly by releasing the hormone cortisol as well as epinephrine to stimulate physiologic changes that we call the fight or flight response. This is a good thing when you need to flee from a predator or win a race.
However, if you are always running away from that same predator, sooner or later this beneficial function will break down and disease or dysfunction will ensue. This is exactly what happens when parents go through a prolonged state of domestic stress or there is workplace or family drama that is unremitting or poorly handled. (Latendresse G. 2009)
Let us divert this story for a second to the connections between breathing and vision?
In a 2020 Scientific American article we find: "But Andrew Huberman, a neuroscientist at Stanford University who studies the visual system, sees matters a bit differently. Stress, he says, is not just about the content of what we are reading or the images we are seeing. It is about how our eyes and breathing change in response to the world, as well as the cascades of events that follow. Both these bodily processes also offer us easy and accessible releases from stress.
Huberman’s assertions are based on both established and emerging science. He has spent the past 20 years unraveling the inner workings of the visual system. In 2018, for example, his laboratory reported its discovery of brain pathways connected with fear and paralysis that respond specifically to visual threats. And a small but growing body of research makes the case that altering our breathing can alter our brain. In 2017 Mark Krasnow of Stanford, Jack Feldman of the University of California, Los Angeles, and their colleagues identified a tight link between neurons responsible for controlling breathing and the region of the brain responsible for arousal and panic." (Wapner 2020)
Did you know that your eyes are actually extrusions of your brain out to receive visual environmental stimuli? This is neuroception. The reception of external signals visually. During embryology, the eyes actually grow directly from the brain into the position that we see them in at birth. In effect, eyes are your brain sitting outside the skull to rapidly assess the external world and make an immediate response to a perceived threat.
When you are stressed fascinating things happen visually. Your pupils will dilate, the eye's lens position changes, an inward rotation of your eyes occurs leading to your field of vision narrowing blurring the periphery focusing everything to the front and close up. This process allows the stressed mammal to visually focus on the perceived threat. This process is intimately tied to the activation of the entire nervous system whereby the hormone cortisol and the neurotransmitters epinephrine, norepinephrine and dopamine flood the system in preparation to run away from the threat. Cortisol activates the release of energy and shuts off inflammation and other non necessary processes for the acute problem.
Think about the evolutionary logic of this system. You are walking in the woods and you see a panther. What happens:
1) Your eyes hyper focus on the threat sending electrical impulses throughout the brain
2) Your brain releases tons of norepinephrine and epinephrine stimulating blood flow via increasing blood pressure and heart stroke volume while shunting blood to your muscles and brain improving mental clarity and arousal for the sole purpose of escape and survival
3) Your adrenal gland releases cortisol increasing sugar availability, mobilizing fat for energy, and decreasing inflammation and other unnecessary metabolic activities
4) You have a brain enhanced memory to the event. This last part is critical to why we remember acute trauma so well. The cortisol response makes sure that the brain remembers where you saw the panther and how to avoid this situation again.
It is an elegant system until we become mismatched between the types of stress, how frequent they are, and for how long. If you can imagine living with a metaphorical panther in your house daily, i.e. abusive relationship, then you will be persistently wide eyed but narrowly focused on the perceived threat. Your stress hormones will be firing all of the time and that has tremendous long term downstream effects including:
1) Metabolic derangements of hyperglycemia, fat deposition and insulin resistance
2) Changes in satiety hormones cause excess eating desires that promote metabolic derangements that for a loop that is self reinforcing. Chronic cortisol and neuropeptide Y drive food driving behavior
3) Inflammation through cortisol response element resistance leading to uncontrolled NFkB release which promotes systemic shifts in inflammatory mediators that promote all disease types
4) Mood fatigue and dysregulation through persistence of excessive epinephrine, norepinephrine and dopamine. The constant state of arousal will task the system into fatigue, anxiety and ultimately depression
5) Sleep architecture is disrupted. Hyperarousal and neurotransmitter activity coupled to cortisol excess has dramatic effects on sleep patterns. Decreased deep sleep and restorative sleep occurs leading to a loop of fatigue and mood changes leading to further dysregulation of hormones and dysregulation and around and around
6) Immune dysregulation promoting poor pathogen killing and increased systemic inflammation
7) Disrupted polyvagal nervous tone leading to states of mental stagnation lacking emotional flexibility promoting loop effects on stress
Remember that these responses are evolutionarily baked in for our safety. Running from a panther takes energy which is the exact reason that the above effects in the short run are so useful. Increased desire to eat, mobilize sugar, be hyper alert and so on are life saving traits for humans. It is only our poor choices that allow these fabulous survival systems to be counter productive for us.
Back to the mothers to be story!
To be stressed chronically will have profound effects on reproductive physiology and general metabolic health. There is a large body of evidence supporting this statement.
As a mother to be, sit with this thought for a while when you are worried about the same unfixable problem of life whatever it may be. As a husband, protect your wife in all things and come to terms with your reality wherever you find yourself. This may sound Pollyannaish and trivial, I assure you thoughts create.
Ok so how do we really tackle this problem actively? Back to the eyeballs and brains!
What is the reversal of stress? Relaxation. If we stare out into the horizon, we in effect visually reverse the process of fight or flight. Thus, it is possible to alter your state of arousal by avoiding a narrow focus and breathing in a 4/7/8 pattern. When I was in Arizona learning from Dr. Weil, he made a point of emphasizing how powerful this 4/7/8 breathing pattern was in inducing the parasympathetic tone of relaxation. The vagus nerve is very responsive to breathing techniques and sound. We will explore this more coming up in a later chapter. Polyvagal theory espoused and taught by Dr. Stephen Porges is critically important here. I have decided to add a whole chapter on it coming up. The act of reducing the negative effects of chronic stress will be a major part of this book.
Picture #1
The newly understood and most dangerous part of chronic unremitting stress is the toll that stress has on the gut. The persistent negative response slows down intestinal transit, changing microbial compositions and alters immune function and inflammation. This negative process causes further cellular dysfunction. I believe that this is one of the inflection points for the development of chronic disease as it relates to stress.
Picture #2
We now know that chronic stress through these and other pathways bring on cellular dysfunction that we perceive as anxiety, depression, stomach aches, headaches, fatigue and malaise!
Is it reversible? Yes.
I have personally seen hundreds of young men and women throw away their anti-depressants after they slowly clean up their diet, work on stress and fix micronutrient/gut function. I am getting ahead of myself a little, we will get there soon. Just know that stress is causing a myriad of abnormal events to occur that are counterproductive to health and ultimately child bearing.
How does this apply to the pre-pregnant mother or the pregnant mother?
The data is clear that chronic stress and in turn mental disease are associated with many negative outcomes for mom and baby. Stress is absolutely associated with preterm births, abnormal neurodevelopment and low birth weights. Newborns and offspring are also more prone to abnormal stress responses.
The hormonal and biochemical pathways that are involved in stress mediation and resolution are critical to a healthy pregnancy. Mother's to be and even young females not interested in pregnancy must consider stress management as a part of a healthy existence. Learning how to handle stress well before it peaks is key. It will go a long way toward avoiding potential negative impacts on maternal health and that of her offspring.
It is clear to me that stress will never leave us, so we have to learn to deal with it effectively. We need to be prepared to do battle when stress arises and then relax when it abates.
How do we mitigate the risks of stress, to become more resilient to stress and to live with gratitude and joy regardless of the environment that we find ourselves in? This is the key to the successes of motivational interviewing. The interviewer meets the patient where they are and nonjudgmentally asks, “what parts of this discussion are you willing to take on and groove in to your daily routine?”
“The greatest disease in the West today is not TB or leprosy; it is being unwanted, unloved, and uncared for. We can cure physical diseases with medicine, but the only cure for loneliness, despair, and hopelessness is love. There are many in the world who are dying for a piece of bread but there are many more dying for a little love. The poverty in the West is a different kind of poverty -- it is not only a poverty of loneliness but also of spirituality. There's a hunger for love, as there is a hunger for God.”
― Mother Teresa, A Simple Path: Mother Teresa
Dr. M
